Severe Vascular Complications Following Thrombolytic Therapy in a Case of Prosthetic Mitral Valve Thrombosis – A Case Report

Prosthetic cardiac valve thrombosis is a rare but dangerous complication; 1,2 particularly in patients with low conformity on anticoagulant therapy. Thromboembolic problems happen after mechanical valve substitution in 0.5 - 8 percent. 3-5 Fibrinolytic therapy to treat the thrombosis is widely used nowadays with high efficacy and no severe side effects as compared to emergency surgical treatment, which is associated with high mortality.6 Surgical valve repair in patients with rheumatic heart disease remains the gold standard for the treatment. Thrombosis of the prosthetic heart valve in patients undergoing valve replacement, is the most severe and deadly complication. Currently, the treatments available for symptomatic prosthetic valve thrombosis are immediate surgery or thrombolytic therapy (TT). In rural hospital settings patients are poor and there is a lack of surgical expertise. These factors make TT the perfect treatment for prosthetic valve thrombosis. But one should be aware of embolic complications.

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Thrombolytic therapy in prosthetic valve thrombosis in the second trimester of pregnancy

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20201625 ◽

2020 ◽

Vol 7 (5) ◽

pp. 853

Author(s):

Santhosh Jadhav ◽

H. S. Natraj Setty ◽

Shankar S. ◽

Phani Teja Mundru ◽

Yeriswamy M. C. ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Valve Replacement ◽

Prosthetic Valve ◽

Prosthetic Heart Valve ◽

Mechanical Valve ◽

Second Trimester ◽

Prosthetic Valve Thrombosis ◽

First Line Therapy ◽

Mechanical Valves ◽

Valve Thrombosis

Pregnancy with mechanical valves requires anticoagulation, the risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected. Prosthetic valve thrombosis during pregnancy requires immediate therapy such as valve replacement, thrombolytic therapy, or surgical thrombectomy. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. We describe a primigravida (second trimester) with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.

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Successful Fibrinolytic Therapy in a Challenging Obstructive Prosthetic Mitral Valve Thrombosis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620921078 ◽

2020 ◽

Vol 8 ◽

pp. 232470962092107

Author(s):

Amr Essa ◽

Toufik Haddad ◽

Terrence Slattery

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

Multimodality Imaging ◽

Fibrinolytic Therapy ◽

Mitral Valve Surgery ◽

Prosthetic Valve Thrombosis ◽

Valve Thrombosis ◽

Mean Pressure ◽

Normal Mean ◽

Prosthetic Mitral Valve

Prosthetic valve thrombosis is a rare and severe complication of the mechanical prosthetic valve. Management can be challenging due to varying clinical presentation, overlapping features of differential diagnosis, and lack of randomized controlled trials on the therapeutic options. In this article, we report the case of a patient with a mechanical prosthetic mitral valve presented with symptoms of heart failure, and an echocardiography showing increased mean pressure gradient across the prosthesis along with a fixed posterior leaflet and a partially restricted anterior leaflet with no visible mass. That raised the concern for an obstructed prosthesis. After multimodality imaging and multidisciplinary team discussions, prosthetic valve thrombosis diagnosis was favored over other different diagnoses that included but not limited to pannus ingrowth. Fibrinolytic therapy was administrated, and the patient was discharged on optimal anticoagulation. Repeated echocardiography a month later showed normal mean gradient and normal functioning prosthetic mitral valve without the need for repeat mitral valve surgery.

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Short-Term Clinical Follow-Up After Thrombolytic Therapy in Patients With Prosthetic Valve Thrombosis: A Single-Center Experience

Cardiology Research ◽

10.14740/cr924 ◽

2019 ◽

Vol 10 (6) ◽

pp. 345-349 ◽

Cited By ~ 2

Author(s):

Akshyaya Pradhan ◽

Monika Bhandari ◽

Vikas Gupta ◽

Pravesh Vishwakarma ◽

Rishi Sethi ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Prosthetic Valve ◽

Single Center ◽

Short Term ◽

Prosthetic Valve Thrombosis ◽

Single Center Experience ◽

Valve Thrombosis

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Assessment of hemodynamic and clinical response in thrombolytic therapy for prosthetic valve thrombosis

Indian Heart Journal ◽

10.1016/j.ihj.2017.09.215 ◽

2017 ◽

Vol 69 ◽

pp. S6 ◽

Cited By ~ 3

Author(s):

B. Midhun Kumar ◽

G. Justin Paul ◽

N. Swaminathan ◽

G. Gnanavelu ◽

G. Ravishankar ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Clinical Response ◽

Prosthetic Valve ◽

Prosthetic Valve Thrombosis ◽

Valve Thrombosis

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Thrombolytic Therapy with Recombinant Streptokinase for Prosthetic Valve Thrombosis

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2001.tb01164.x ◽

2010 ◽

Vol 17 (5) ◽

pp. 387-393 ◽

Cited By ~ 9

Author(s):

Horacio Pérez López ◽

Fidel Manuel Cáceres Lóriga ◽

Karel Morlans Hernàndez ◽

Humberto Fagundo Sánchez ◽

Noel González Jimenez ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Prosthetic Valve ◽

Prosthetic Valve Thrombosis ◽

Valve Thrombosis

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Abstract 1120: Chest Pain and Dyspnea in a Pregnant Woman with a Prosthetic Valve

Circulation ◽

10.1161/circ.118.suppl_18.s_647-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jameel Ahmed ◽

George Philippides ◽

Michael Klein

Keyword(s):

Chest Pain ◽

Aortic Valve ◽

Physical Examination ◽

Prosthetic Valve ◽

Mechanical Valve ◽

Pregnant Female ◽

Transthoracic Echocardiogram ◽

Posterior Leaflet ◽

Prosthetic Valve Thrombosis ◽

Valve Thrombosis

A 31 year old pregnant female at nine weeks gestation presented with a complaint of recurrent chest pain and dyspnea. The patient had undergone aortic valve replacement with a bileaflet mechanical valve at 25 years of age. Most recently, she had been anti-coagulated with low-molecular weight heparin. The patient had missed two doses of enoxaparin over the prior week. Physical examination was notable for muffled, but audible mechanical valve sounds with an early peaking, systolic murmur over the right sternal border. Transthoracic echocardiogram revealed an elevated mean trans-aortic gradient of 38 mm Hg. Of note, echocardiogram at an outside hospital six days earlier had revealed normal gradients. Trans-esophageal echocardiography was performed, which revealed a poorly mobile posterior leaflet without large thrombus, and confirmed elevated gradients. Fluoroscopy of the aortic prosthesis also revealed a fixed posterior leaflet. A presumptive diagnosis of prosthetic valve obstruction (PVO) due to prosthetic valve thrombosis (PVT) was made. After discussion with the patient, intravenous tissue plasminogen activator was administered. Fluoroscopy the following day revealed both aortic valve leaflets to be fully mobile and transthoracic echocardiogram demonstrated normal trans-aortic gradients. Patient was anti-coagulated with enoxaparin until twelve weeks gestation and with coumadin for the duration of her pregnancy. At 37 weeks, a healthy, baby boy was delivered. PVO can be caused by thrombus, pannus formation or endocarditis. PVT is the most common etiology, with an annual rate of 0.5 to 8%. An increase in clotting factors during pregnancy results in a physiologic hypercoagulable state and higher rates of thromboembolic complications. Management options of PVT include surgery or intravenous thrombolytic therapy. Trans-esophageal echocardiography can be used to help guide management. This case illustrates the difficulties in the diagnosis and management of a relatively uncommon condition (prosthetic valve thrombosis) in a common patient (pregnant female). In conjunction with the clinical history and physical examination, various imaging modalities were utilized to arrive at a likely diagnosis and formulate a management plan.

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